- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $338.84 / $3,090.30
| Facility | | $181.97 | $338.84 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $158.49 / $251.19 / $426.58
| Professional | | $158.49 | $251.19 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $416.87 / $1,148.15
| Professional | | $213.80 | $416.87 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $676.08 / $794.33 / $1,258.93
| Facility | | $676.08 | $794.33 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $204.17 / $436.52 / $1,071.52
| Professional | | $204.17 | $436.52 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $288.40 / $3,311.31
| Facility | | $165.96 | $288.40 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $302.00 / $457.09 / $707.95
| Professional | | $302.00 | $457.09 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $165.96 / $295.12 / $3,981.07
| Facility | | $165.96 | $295.12 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $588.84 / $1,862.09
| Professional | | $269.15 | $588.84 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $239.88
| Professional | | $32.36 | $33.11 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $363.08 / $3,890.45 / $4,570.88
| Facility | | $363.08 | $3,890.45 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $512.86 / $794.33
| Professional | | $281.84 | $512.86 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $263.03 / $489.78 / $870.96
| Professional | | $263.03 | $489.78 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $269.15 / $2,187.76 / $2,187.76
| Facility | | $269.15 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $199.53 / $549.54 / $1,819.70
| Professional | | $199.53 | $549.54 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $954.99
| Professional | | $602.56 | $602.56 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $512.86 / $870.96 / $1,288.25
| Professional | | $512.86 | $870.96 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,754.23 / $3,548.13 / $7,244.36
| Facility | | $2,754.23 | $3,548.13 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $323.59 / $891.25
| Professional | | $181.97 | $323.59 | $891.25 |